Startseite Medizin Optimizing measurement of misdiagnosis-related harms using symptom-disease pair analysis of diagnostic error (SPADE): comparison groups to maximize SPADE validity
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Optimizing measurement of misdiagnosis-related harms using symptom-disease pair analysis of diagnostic error (SPADE): comparison groups to maximize SPADE validity

  • Ava L. Liberman ORCID logo EMAIL logo , Zheyu Wang , Yuxin Zhu , Ahmed Hassoon , Justin Choi , J. Matthew Austin , Michelle C. Johansen und David E. Newman-Toker
Veröffentlicht/Copyright: 5. April 2023
Diagnosis
Aus der Zeitschrift Diagnosis Band 10 Heft 3

Abstract

Diagnostic errors in medicine represent a significant public health problem but continue to be challenging to measure accurately, reliably, and efficiently. The recently developed Symptom-Disease Pair Analysis of Diagnostic Error (SPADE) approach measures misdiagnosis related harms using electronic health records or administrative claims data. The approach is clinically valid, methodologically sound, statistically robust, and operationally viable without the requirement for manual chart review. This paper clarifies aspects of the SPADE analysis to assure that researchers apply this method to yield valid results with a particular emphasis on defining appropriate comparator groups and analytical strategies for balancing differences between these groups. We discuss four distinct types of comparators (intra-group and inter-group for both look-back and look-forward analyses), detailing the rationale for choosing one over the other and inferences that can be drawn from these comparative analyses. Our aim is that these additional analytical practices will improve the validity of SPADE and related approaches to quantify diagnostic error in medicine.

Keywords: delayed diagnosis; diagnostic errors; missed diagnosis; outcome assessment, health care; quality improvement; stroke
Corresponding author: Ava L. Liberman, MD, Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, 420 East 70th Street, NY, 10021, USA, Phone: 212-746-0225, Fax: 646-962-0126, E-mail:

Funding source: NIH research grant

Award Identifier / Grant number: K23NS107643

Award Identifier / Grant number: K23NS112459

Funding source: AHRQ research grant

Award Identifier / Grant number: R01HS27614

Funding source: Armstrong Institute Center for Diagnostic Excellence

  1. Research funding: NIH research grant K23NS107643 supports Dr. Liberman. NIH research grant K23NS112459 supports Dr. Johansen. AHRQ research grant R01HS27614 supports Drs. Wang, Zhu, Hassoon, Austin, and Newman-Toker. Dr. Newman-Toker’s effort was also partially supported by the Armstrong Institute Center for Diagnostic Excellence. No financial support for this study was provided by contract with any other agency, foundation, company, institute, or philanthropic foundation.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Dr. Newman-Toker conducts research related to diagnosis of dizziness and stroke, as well as diagnostic error (including the SPADE method). He serves as the principal investigator for multiple grants and contracts on these topics. Johns Hopkins has been loaned research equipment (video-oculography [VOG] systems) by two companies for use in Dr. Newman-Toker’s research; one of these companies has also provided funding for research on diagnostic algorithm development related to dizziness, inner ear diseases, and stroke. Dr. Newman-Toker has no other financial interest in these or any other companies. Dr. Newman-Toker is an inventor on a provisional patent (US No. 62/883,373) for smartphone-based stroke diagnosis in patients with dizziness. He gives frequent academic lectures on these topics and occasionally serves as a medico-legal consultant for both plaintiff and defense in cases related to dizziness, stroke, and diagnostic error. There are no other conflicts of interest. None of the authors have any financial or personal relationships with other people or organizations that could inappropriately influence (bias) their work.

  4. Informed consent: Not applicable.

  5. Ethical approval: Not applicable.

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Received: 2022-11-28
Accepted: 2023-03-06
Published Online: 2023-04-05

© 2023 Walter de Gruyter GmbH, Berlin/Boston

Artikel in diesem Heft

  1. Frontmatter
  2. Review
  3. Cognitive biases in internal medicine: a scoping review
  4. Opinion Papers
  5. “Pivot and Cluster Strategy” in the light of Kahneman’s “Decision Hygiene” template
  6. Developing a European longitudinal and interprofessional curriculum for clinical reasoning
  7. Optimizing measurement of misdiagnosis-related harms using symptom-disease pair analysis of diagnostic error (SPADE): comparison groups to maximize SPADE validity
  8. Reframing context specificity in team diagnosis using the theory of distributed cognition
  9. Original Articles
  10. Promoting clinical reasoning with meta-memory techniques to teach broad differential diagnosis generation in a pediatric core clerkship
  11. Semantic competence and prototypical verbalizations are associated with higher OSCE and global medical degree scores: a multi-theory pilot study on year 6 medical student verbalizations
  12. Influence of comorbid depression and diagnostic workup on diagnosis of physical illness: a randomized experiment
  13. Recognition, diagnostic practices, and cancer outcomes among patients with unintentional weight loss (UWL) in primary care
  14. Quantitation of neurofilament light chain protein in serum and cerebrospinal fluid from patients with multiple sclerosis using the MSD R-PLEX NfL assay
  15. Analysis of common biomarkers in capillary blood in routine clinical laboratory. Preanalytical and analytical comparison with venous blood
  16. Comparison between cerebrospinal fluid biomarkers for differential diagnosis of acute meningitis
  17. Short Communications
  18. Exploring relationships between physician stress, burnout, and diagnostic elements in clinician notes
  19. Development of a student-created internal medicine frameworks website for healthcare trainees
  20. Case Report - Lessons in Clinical Reasoning
  21. Lessons in clinical reasoning – pitfalls, myths, and pearls: a case of crushing, substernal chest pain
  22. Letters to the Editor
  23. Ample room for cognitive bias in diagnosing accidental hypothermia
  24. Auscultation order of lung and heart sounds and autonomous noise cancellation
  25. Reliability of a single-nostril nasopharyngeal swab for diagnosing SARS-CoV-2 infection
https://doi.org/10.1515/dx-2022-0130
Schlagwörter für diesen Artikel
delayed diagnosis; diagnostic errors; missed diagnosis; outcome assessment, health care; quality improvement; stroke

Artikel in diesem Heft

  1. Frontmatter
  2. Review
  3. Cognitive biases in internal medicine: a scoping review
  4. Opinion Papers
  5. “Pivot and Cluster Strategy” in the light of Kahneman’s “Decision Hygiene” template
  6. Developing a European longitudinal and interprofessional curriculum for clinical reasoning
  7. Optimizing measurement of misdiagnosis-related harms using symptom-disease pair analysis of diagnostic error (SPADE): comparison groups to maximize SPADE validity
  8. Reframing context specificity in team diagnosis using the theory of distributed cognition
  9. Original Articles
  10. Promoting clinical reasoning with meta-memory techniques to teach broad differential diagnosis generation in a pediatric core clerkship
  11. Semantic competence and prototypical verbalizations are associated with higher OSCE and global medical degree scores: a multi-theory pilot study on year 6 medical student verbalizations
  12. Influence of comorbid depression and diagnostic workup on diagnosis of physical illness: a randomized experiment
  13. Recognition, diagnostic practices, and cancer outcomes among patients with unintentional weight loss (UWL) in primary care
  14. Quantitation of neurofilament light chain protein in serum and cerebrospinal fluid from patients with multiple sclerosis using the MSD R-PLEX NfL assay
  15. Analysis of common biomarkers in capillary blood in routine clinical laboratory. Preanalytical and analytical comparison with venous blood
  16. Comparison between cerebrospinal fluid biomarkers for differential diagnosis of acute meningitis
  17. Short Communications
  18. Exploring relationships between physician stress, burnout, and diagnostic elements in clinician notes
  19. Development of a student-created internal medicine frameworks website for healthcare trainees
  20. Case Report - Lessons in Clinical Reasoning
  21. Lessons in clinical reasoning – pitfalls, myths, and pearls: a case of crushing, substernal chest pain
  22. Letters to the Editor
  23. Ample room for cognitive bias in diagnosing accidental hypothermia
  24. Auscultation order of lung and heart sounds and autonomous noise cancellation
  25. Reliability of a single-nostril nasopharyngeal swab for diagnosing SARS-CoV-2 infection
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